scholarly journals Thirty-day readmission after endovascular or surgical revascularization for chronic mesenteric ischemia: Insights from the Nationwide Readmissions Database

2019 ◽  
Vol 24 (3) ◽  
pp. 216-223 ◽  
Author(s):  
Fabio V Lima ◽  
Dhaval Kolte ◽  
David W Louis ◽  
Kevin F Kennedy ◽  
J Dawn Abbott ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Skilled Nursing Facility ◽  
Home Healthcare ◽  
Index Admission ◽  
Chronic Mesenteric Ischemia ◽  
Surgical Revascularization ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
National Estimates

There are limited contemporary data on readmission after revascularization for chronic mesenteric ischemia (CMI). This study aimed to determine the rates, reasons, predictors, and costs of 30-day readmission after endovascular or surgical revascularization for CMI. Patients with CMI discharged after endovascular or surgical revascularization during 2013 to 2014 were identified from the Nationwide Readmissions Database. The rates, reasons, length of stay, and costs of 30-day all-cause, non-elective, readmission were determined using weighted national estimates. Independent predictors of 30-day readmission were determined using hierarchical logistic regression. Among 4671 patients with CMI who underwent mesenteric revascularization, 19.5% were readmitted within 30 days after discharge at a median time of 10 days. More than 25% of readmissions were for cardiovascular or cerebrovascular conditions, most of which were for peripheral or visceral atherosclerosis and congestive heart failure. Independent predictors of 30-day readmission included non-elective index admission, chronic kidney disease (CKD), and discharge to home healthcare or to a skilled nursing facility. Revascularization modality did not independently predict readmission. In a nationwide, retrospective analysis of patients with CMI undergoing revascularization, approximately one in five were readmitted within 30 days. Predictors were largely non-modifiable and included non-elective index admission, CKD, and discharge disposition.

scholarly journals Racial Disparities in 30-Day Outcomes Following Index Admission for COVID-19

2021 ◽  
Vol 8 ◽  
Author(s):  
Vivek Nimgaonkar ◽  
Jeffrey C. Thompson ◽  
Lauren Pantalone ◽  
Tessa Cook ◽  
Despina Kontos ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Acute Care ◽  
Odds Ratio ◽  
Skilled Nursing Facility ◽  
Index Admission ◽  
Composite Outcome ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Black Patients ◽  
Post Acute Care

We investigated racial disparities in a 30-day composite outcome of readmission and death among patients admitted across a 5-hospital health system following an index COVID-19 admission. A dataset of 1,174 patients admitted between March 1, 2020 and August 21, 2020 for COVID-19 was retrospectively analyzed for odds of readmission among Black patients compared to all other patients, with sequential adjustment for demographics, index admission characteristics, type of post-acute care, and comorbidities. Tabulated results demonstrated a significantly greater odds of 30-day readmission or death among Black patients (18.0% of Black patients vs. 11.3% of all other patients; Univariate Odds Ratio: 1.71, p = 0.002). Sequential adjustment via logistic regression revealed that the odds of 30-day readmission or death were significantly greater among Black patients after adjustment for demographics, index admission characteristics, and type of post-acute care, but not comorbidities. Stratification by type of post-acute care received on discharge revealed that the same disparity in odds of 30-day readmission or death existed among patients discharged home without home services, but not those discharged to home with home services or to a skilled nursing facility or acute rehab facility. Collectively, the findings suggest that weighing comorbidity burdens in post-acute care decisions may be relevant in addressing racial disparities in 30-day outcomes following discharge from an index COVID-19 admission.

scholarly journals Outcomes of Patients With Cancer Discharged to a Skilled Nursing Facility After Acute Care Hospitalization

2020 ◽  
Vol 18 (7) ◽  
pp. 856-865
Author(s):  
Sarguni Singh ◽  
Megan Eguchi ◽  
Sung-Joon Min ◽  
Stacy Fischer
Keyword(s):  
Acute Care ◽  
Skilled Nursing Facility ◽  
Home Healthcare ◽  
Categorical Variables ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Patients With Cancer ◽  
Patient Goals ◽  
Patient Groups ◽  
To Receive

Background: After discharge from an acute care hospitalization, patients with cancer may choose to pursue rehabilitative care in a skilled nursing facility (SNF). The objective of this study was to examine receipt of anticancer therapy, death, readmission, and hospice use among patients with cancer who discharge to an SNF compared with those who are functionally able to discharge to home or home with home healthcare in the 6 months after an acute care hospitalization. Methods: A population-based cohort study was conducted using the SEER-Medicare database of patients with stage II–IV colorectal, pancreatic, bladder, or lung cancer who had an acute care hospitalization between 2010 and 2013. A total of 58,770 cases were identified and patient groups of interest were compared descriptively using means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Logistic regression was used to compare patient groups, adjusting for covariates. Results: Of patients discharged to an SNF, 21%, 17%, and 2% went on to receive chemotherapy, radiotherapy, and targeted chemotherapy, respectively, compared with 54%, 28%, and 6%, respectively, among patients discharged home. Fifty-six percent of patients discharged to an SNF died within 6 months of their hospitalization compared with 36% discharged home. Thirty-day readmission rates were 29% and 28% for patients discharged to an SNF and home, respectively, and 12% of patients in hospice received <3 days of hospice care before death regardless of their discharge location. Conclusions: Patients with cancer who discharge to an SNF are significantly less likely to receive subsequent oncologic treatment of any kind and have higher mortality compared with patients who discharge to home after an acute care hospitalization. Further research is needed to understand and address patient goals of care before discharge to an SNF.

Abstract P52: Absence of Dysphagia is a Stronger Predictor of Favorable Discharge Disposition than Stroke Severity: Insights from the UTHSC Houston Stroke Registry

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Nneka I Jones ◽  
Nusrat Harun ◽  
Elizabeth Noser ◽  
James Grotta
Keyword(s):  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Stroke Care ◽  
Level Of Care ◽  
Stroke Severity ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Stroke Registry ◽  
Post Stroke ◽  
Discharge Disposition

Introduction: Dysphagia is one of the most common post-stroke complications. The use of feeding tubes to provide nutrition requires increased acuity of care for management, which affects costs. This care is provided at all levels, including Inpatient Rehabilitation (IR), Skilled Nursing Facility (SNF) or Sub-acute (Sub). There are limited studies of the role of dysphagia as a predictor of post-stroke disposition. Hypothesis: Low NIHSS is a predictor of higher function. We assessed the hypothesis that the absence of tube feeds as an indicator of dysphagia is a predictor of post-stroke disposition to a similar functional level. Methods: All patients admitted to the UT Stroke Service between January 2004 and October 2009 were included. Stratification occurred for age >65, NIHSS and stroke risk factors. Using multivariate logistic regression, the data was analyzed to determine if differences in post-stroke disposition were present among patients not receiving tube feeds as an indicator of dysphagia. Results: Home vs. Other Level of Care Of 3389 patients, 1668 were discharged home, 1721 to another level of care. Patients without tube feeds are 14.6 times more likely to be discharged home (P = <.0001, OR 14.66, 95% CI 8.05 to 26.69) Patients with NIHSS < 8 are 10.9 times more likely to be discharged home. IR vs. SNF Of 1546 patients, 983 were discharged to acute IR, 563 to SNF. Patients without tube feeds are 6.1 times more likely to be discharged to IR (P = <.0001, OR 6.118, 95% CI 4.34 to 8.63). Patients with NIHSS < 8 are 2.5 times more likely to be discharged to IR. SNF vs. Sub Of 738 patients, 563 were discharged to SNF, 175 to Sub. Patients without tube feeds are 3 times more likely to be discharged to SNF (P = <.0001, OR 2.999, 95% CI 2.048 to 4.390). Patients with NIHSS < 8 are 2 times more likely to be discharged to SNF. Conclusions: The absence of tube feeds as an indicator of dysphagia is a predictor of improved post-stroke disposition, with a correlation stronger than NIHSS. This study is limited by its retrospective nature and unmeasured psychosocial factors related to discharge. Prospective studies should focus on early diagnosis, therapeutic intervention and caregiver involvement in dysphagia education to improve outcomes and decrease the cost of post-stroke care.

Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis

Surgery ◽  
2019 ◽  
Vol 166 (4) ◽  
pp. 489-495 ◽  
Author(s):  
Anghela Z. Paredes ◽  
Azeem T. Malik ◽  
Marcus Cluse ◽  
Scott A. Strassels ◽  
Heena P. Santry ◽  
...  
Keyword(s):  
General Surgery ◽  
Poor Prognosis ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition

scholarly journals Predictors of 30-day readmission after aneurysmal subarachnoid hemorrhage: a case-control study

2016 ◽  
Vol 126 (6) ◽  
pp. 1847-1854 ◽  
Author(s):  
Jacob K. Greenberg ◽  
Ridhima Guniganti ◽  
Eric J. Arias ◽  
Kshitij Desai ◽  
Chad W. Washington ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Subarachnoid Hemorrhage ◽  
Case Control Study ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Skilled Nursing Facility ◽  
Case Control ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Control Study

OBJECTIVEDespite persisting questions regarding its appropriateness, 30-day readmission is an increasingly common quality metric used to influence hospital compensation in the United States. However, there is currently insufficient evidence to identify which patients are at highest risk for readmission after aneurysmal subarachnoid hemorrhage (SAH). The objective of this study was to identify predictors of 30-day readmission after SAH, to focus preventative efforts, and to provide guidance to funding agencies seeking to risk-adjust comparisons among hospitals.METHODSThe authors performed a case-control study of 30-day readmission among aneurysmal SAH patients treated at a single center between 2003 and 2013. To control for geographic distance from the hospital and year of treatment, the authors randomly matched each case (30-day readmission) with approximately 2 SAH controls (no readmission) based on home ZIP code and treatment year. They evaluated variables related to patient demographics, socioeconomic characteristics, comorbidities, presentation severity (e.g., Hunt and Hess grade), and clinical course (e.g., need for gastrostomy or tracheostomy, length of stay). Conditional logistic regression was used to identify significant predictors, accounting for the matched design of the study.RESULTSAmong 82 SAH patients with unplanned 30-day readmission, the authors matched 78 patients with 153 nonreadmitted controls. Age, demographics, and socioeconomic factors were not associated with readmission. In univariate analysis, multiple variables were significantly associated with readmission, including Hunt and Hess grade (OR 3.0 for Grade IV/V vs I/II), need for gastrostomy placement (OR 2.0), length of hospital stay (OR 1.03 per day), discharge disposition (OR 3.2 for skilled nursing vs other disposition), and Charlson Comorbidity Index (OR 2.3 for score ≥ 2 vs 0). However, the only significant predictor in the multivariate analysis was discharge to a skilled nursing facility (OR 3.2), and the final model was sensitive to criteria used to enter and retain variables. Furthermore, despite the significant association between discharge disposition and readmission, less than 25% of readmitted patients were discharged to a skilled nursing facility.CONCLUSIONSAlthough discharge disposition remained significant in multivariate analysis, most routinely collected variables appeared to be weak independent predictors of 30-day readmission after SAH. Consequently, hospitals interested in decreasing readmission rates may consider multifaceted, cost-efficient interventions that can be broadly applied to most if not all SAH patients.

Discharge to a skilled nursing facility as the strongest modifiable risk factor for readmissions following pancreaticoduodenectomy.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 435-435
Author(s):  
Katelin Anne Mirkin ◽  
Christopher S Hollenbeak ◽  
Amanda Beth Cooper ◽  
Niraj Jaysukh Gusani
Keyword(s):  
Health Care Cost ◽  
Skilled Nursing Facility ◽  
Home Healthcare ◽  
Readmission Rates ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Black Race ◽  
Anastomotic Complications ◽  
Common Causes ◽  
Initial Hospital

435 Background: Pancreaticoduodenectomy is a technically difficult and notoriously morbid procedure. As payers begin to link reimbursement to readmission rates, there is growing interest in understanding and preventing readmissions. The objective of this study was to evaluate factors contributing to 30-day readmission rates for patients undergoing pancreaticoduodenectomy. Methods: Data from the Pennsylvania Health Care Cost Containment Council (PHC4) were reviewed for patients undergoing pancreaticoduodenectomy from 2011-2014 (n = 1,552). Outcomes included 30-day readmission and length of stay (LOS). Univariate comparisons were performed between characteristics of those readmitted (n = 404) and not readmitted (n = 1,148). Readmission and LOS were modeled using multivariate logistic regression and linear regression, respectively. Results: Of the 404 (26.0%) patients who were readmitted, the most common causes for readmission were post-operative infection (26.2%), anastomotic complications (8.0%), and dehydration (5.7%). Patients who were readmitted were more likely to be discharged to a skilled nursing facility (SNF) and were associated with a longer LOS of index admission (p < 0.001, both). In multivariate analysis, black race (HR 1.96, p = 0.001), discharge to a SNF (HR 1.73, p = 0.006) and increased LOS (HR 1.36, p = 0.019), were associated with increased odds of readmission. After controlling for patient, admission, and facility characteristics, black race, urgent and emergent admissions, and discharge to a SNF or home with home healthcare, were predictive of a longer LOS (p < 0.05). High surgeon volume, and high hospital volume were associated with a shorter LOS (p < 0.05). Conclusions: The most common causes of readmission following pancreaticoduodenectomy in Pennsylvania from 2011-2014 were post-operative infection, anastomotic complications, and dehydration. Patients with a longer initial hospital stay and those discharged to a SNF were associated with higher odds of readmission. Understanding the interplay of these factors may result in opportunities to prevent readmissions, and improve outcomes in patients undergoing this complex surgery.

scholarly journals Comparison of 90-Day Perioperative Outcomes in Shoulder Arthroplasty Between the Elderly and Nonelderly Patients

2018 ◽  
Vol 9 ◽  
pp. 215145931880384
Author(s):  
Paul D. Crook ◽  
William C. Foster ◽  
Stephen L. Kates ◽  
Jonathan R. Korpon ◽  
Gustavo A. Ortega ◽  
...  
Keyword(s):  
Risk Factor ◽  
Elderly Patients ◽  
Complication Rate ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Skilled Nursing Facility ◽  
The Elderly ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition

Introduction: As life expectancy increases, the incidence of shoulder arthroplasty continues to increase as well. There are few shoulder arthroplasty studies investigating perioperative complication, readmission, and mortality. Furthermore, with bundled payments on the horizon, the cost of shoulder arthroplasty has become a significant issue. Clarifying risk factors for the need for postdischarge acute care will be critical information due to the high cost of such care. The goal of this study was to compare discharge disposition, length of stay (LOS), perioperative complications, readmission, and mortality in elderly and nonelderly cohorts to determine whether age is a risk factor for shoulder arthroplasty. Materials and Methods: We retrospectively compared 89 elderly patients (80 years or older) and 86 nonelderly patients (79 years or younger) who underwent hemiarthroplasty, total shoulder arthroplasty, reverse total shoulder arthroplasty, or revision shoulder arthroplasty from 2007 to 2015. Baseline characteristics were compared between the 2 cohorts. We then compared discharge disposition, LOS, 90-day complication rate, readmission, and mortality between the 2 cohorts. Results: Average length of hospitalization and percentage of patients with greater than 2 days of hospitalization were significantly higher in the elderly cohorts. Forty-four percent of the elderly cohorts were discharged to a skilled nursing facility compared to 6% in the nonelderly cohorts ( P < .0001). There were no significant differences found in 90-day major complication rate, readmission, or mortality. Discussion: Shoulder arthroplasty is a valuable surgery for various indications in the elderly population. However, the likelihood of a patient to need a prolonged hospitalization or skilled nursing facility care after surgery are important questions that need to be answered. Our study shows that age over 80 years is a risk factor for prolonged hospitalization and need for skilled nursing facility care after shoulder arthroplasty. Conclusion: We conclude that elderly patients who undergo shoulder arthroplasty are significantly more likely to have extended hospitalizations and to be discharged to skilled nursing facilities compared to nonelderly patients.

scholarly journals Integration of Geriatrician Consultation for Trauma Admissions May Benefit Patient Outcomes

2019 ◽  
Vol 5 ◽  
pp. 233372141985873 ◽  
Author(s):  
Sumit Saha ◽  
Stephen M. DiRusso ◽  
Scott Welle ◽  
Benjamin Lieberman ◽  
Joel Sender ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Patient Discharge ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Outpatient Services ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Benefit Patient

Objective: Geriatric admissions to trauma centers have increased, and in 2013, our center integrated geriatrician consultation with the management of admitted patients. Our goal is to describe our experience with increasing geriatric fall volume to help inform organized geriatric trauma programs. Method: We retrospectively analyzed admitted trauma patients ≥65 years old, suffering falls from January 1, 2006, to December 31, 2017. We examined descriptive statistics and changes in outcomes after integration. Results: A total of 1,335 geriatric trauma patients were admitted, of which 1,054 (79%) had suffered falls. Falls increased disproportionately (+280%) compared with other mechanisms of injury (+97%). After 2013, patient discharge disposition to skilled nursing facility decreased significantly (–67%, p < .001), with a concomitant increase in safe discharges home with outpatient services. Regression analysis revealed association between integration of geriatrician consultation and outcomes. Discussion: Geriatrician consultation is associated with optimized discharge disposition of trauma patients. We recommend geriatrician consultation for all geriatric trauma activations.

Total Knee Arthroplasty in Patients with Dementia

2020 ◽  
Author(s):  
Nicholas M. Hernandez ◽  
Daniel J. Cunningham ◽  
William A. Jiranek ◽  
Michael P. Bolognesi ◽  
Thorsten M. Seyler
Keyword(s):  
Emergency Department ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
National Database ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Total Knee

AbstractThere are few studies evaluating total knee arthroplasty (TKA) in patients with dementia. The purpose of this study was to evaluate the rate of revision, complication, emergency department (ED) visitation, and discharge disposition in patients with dementia undergoing primary TKA. In this retrospective study, we evaluated patients from 2007 to 2017 using a national database. Ninety-day complications in patients with dementia undergoing TKA were increased risk of ED visitation and skilled nursing facility (SNF) disposition (p  ≤  0.05). Two-year complications in patients with dementia undergoing TKA were increased risk of ED visitation and SNF disposition (p  ≤  0.05). Patients with dementia undergoing TKA are at an increased risk of resource utilization.

scholarly journals Clinical and Socioeconomic Differences in Methamphetamine-Positive Burn Patients

2019 ◽  
Vol 40 (6) ◽  
pp. 734-742
Author(s):  
Eve A Solomon ◽  
David G Greenhalgh ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
Kathleen S Romanowski
Keyword(s):  
Socioeconomic Status ◽  
Skilled Nursing Facility ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Lower Socioeconomic Status ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Methamphetamine Use ◽  
Discharge Disposition ◽  
Lower Socioeconomic

Abstract Previous research on burn patients who test positive for methamphetamines (meth) has yielded mixed results regarding whether meth-positive status leads to worse outcomes and longer hospitalizations. We hypothesized that meth-positive patients at our regional burn center would have worse outcomes. We reviewed burn admissions from January 2014 to December 2017 and compared total patients versus meth-positive, and matched meth-negative versus meth-positive for total BSA burn, length of stay (LOS), intensive care unit (ICU) days, days on ventilator, discharge status (lived/died), number of operating room (OR) visits, number of procedures, socioeconomic status, comorbidities, and discharge disposition. Of 1363 total patients, 264 (19.4%) were meth-positive on toxicology screen. We matched 193 meth-positive patients with meth-negative controls based on TBSA burn, age, and inhalation injury. In the total population comparison, meth-positive patients had larger burns (15.6% vs 12.2%; P = .004), longer LOS (17.8 vs 14.3 days; P = .041), and fewer operations/TBSA (0.12 vs 0.2; P = .04), and lower socioeconomic status. Meth-positive patients were less likely to be discharged to a skilled nursing facility, and more likely to leave against medical advice. In the matched patients, we found no significant differences in LOS or OR visits/TBSA burn. Meth-positive patients have lower socioeconomic status, larger burns, and longer LOS compared to the total burn population. Methamphetamine use, by itself, does not appear to change outcomes. Methamphetamine use leads to larger burns in a population with fewer resources than the general population.

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